IF YOU ARE REPRESENTED BY AN ATTORNEY, YOU CANNOT SUBMIT THIS FORM, BUT INSTEAD MUST HAVE YOUR ATTORNEY CONTACT OUR OFFICE. You May Use This Form To Request A Payment Plan, but IT IS ONLY A REQUEST. You Will Be Notified Whether It Is Accepted Or Denied. If It Is Accepted You Will Receive A Promissory Note To Sign And Return. If You Make A Payment Prior To Acceptance, It Will Simply Be Considered A Partial Payment On Your Balance. This Law Firm Is Deemed A 'Debt Collector' Under The Fair Debt Collection Practices Act. We Are Attempting To Collect A Debt, And Any Information Obtained Will Be Used For That Purpose.

LOT OR UNIT INFORMATION

Subdivision Name:

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Property Street Address:

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City:

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State:

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Zip Code:

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YOUR CONTACT INFORMATION

Full Name:

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Street Address:

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City:

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State:

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Zip Code:

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Email Address:

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Cell Phone:

Home Phone:

PAYMENT PLAN REQUEST

If Prior To Lien: Request Must Be For At Least 50 PercentDown And For No More Than 3 Monthly Payments.

Down Payment:

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Payments:

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Any Comments:

By Submitting This Request I Understand That $50 In Atty FeesWill Be Added To My Account For Drafting The Promissory Note,And Another $50 Will Be Added For Processing TheInstallments And For Every Six Months More Of Installments Or Any Fraction Thereof. In Addition, Interest Will Be Added At The Allowed Annual Rate.I Further Understand That Requesting A Payment Plan Will Not Result In The Cessation Of Collection Efforts.